Health Net, an IPA model commercial health plan, under contract with the California Department of Health Services and California’s Managed Risk Medical Insurance Board, has been a major participant in the implementation and operation of Medi-Cal managed care and Healthy Families, California’s adaptation of the national Children’s Health Insurance Program (CHIP). Health Net’s Medi-Cal and Healthy Families members throughout the state include a significant number of children with special health care needs (CSHCN). Health Net is committed to providing member children with a medical home where health care services are accessible, family-centered, coordinated and culturally competent. In both Medi-Cal managed care and Healthy Families, the care for certain medical diagnoses in children is “carved-out” of the health plan’s scope and responsibility falls to California Children Services (CCS). However, primary care and the creation of a medical home remains the responsibility of the individual child’s health-plan-contracted primary care provider. This presentation will review the ways in which Health Net is involved in local, state and national efforts to implement this optimal system of care for all children, especially CSHCN, including: (1) dissemination of tools to primary care providers and medical groups that promote the coordination of care with CCS and other public health programs and services; (2) provision of direct technical assistance to medical groups and IPAs; (3) actions of past and current task forces and work groups of stakeholders that have the capacity to respond to recommendations and initiatives; and (4) recommendations for moving forward.
Learning Objectives: 1. Describe the meaning of the medical home concept and how it applies to children in California’s Medi-Cal managed care and Healthy Families programs. 2. Identify at least three stakeholders in the initiative to create medical homes for CSHCN. 3. List three action steps that can be replicated by medical groups and health plans
Keywords: Managed Care, Children With Special Needs
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.